CIO one-on-one: patient engagement

‘You can't continue the old way of doing business when you're bringing in these new ways of doing business'
By Erin McCann
10:16 AM
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Edward Martinez

For the folks at Miami Children’s Hospital, patient engagement is far more than a Stage 2 meaningful use hurdle. On the contrary. Rather, it’s regarded as an opportunity, an organization-wide lifestyle that has huge implications for clinical care and the hospital’s bottom line.

[Learn: Patient Engagement Summit]

Edward Martinez, the hospital’s chief information officer, has made patient engagement and care coordination a top priority at the 289-bed Miami Children’s in southern Florida – for good reason.

We caught up with Martinez, who is among 30 industry leaders speaking at the Healthcare IT News and HIMSS Media Patient Engagement Summit, February 9-10 in Orlando, to hear more about how Children’s is leveraging mobile health and care coordination initiatives to improve outcomes. And, as Martinez points out, it’s not just about developing the technology; it’s about embracing a new way of doing business across the enterprise.

[See also: For portals, speak patients' language]

Q: Talk a little bit about what you’ll be speaking about at the Patient Engagement Summit next month.

A: I am going to start off talking about how we used to run the hospital business and how the business has changed, and you have to engage the patient in order to improve outcomes and reduce costs. I am going to show basically how we used to work a business – if you want to call a hospital a business – we used to run it as, 'you had an appointment; you showed up for the appointment; the doctor saw you; they gave you the medication; you go home, and you're done.' And now, with mobile technology, we're able to engage with that patient well before they show up at a doctor, provide educational materials, provide updates, provide text, provide a lot of different content that wasn't available at one point. And if it happens to be an admission to the hospital, the interesting thing is that whole process can also occur during the hospital stay, so you or a family member – in our case, we're a children's hospital, so mom and the dad is a critical element here – is engaged in the care of the child, and we're informing them throughout the stay, whether it's an outpatient visit or an inpatient visit, what are we doing to them, what kind of medications we're giving to them, what do they do, what are they for.

I'll talk a bit about the variation on how technology moves from point of care to virtual point of care, where there's telemedicine technology, where there's other things that engage the patient from different perspectives to make sure we’re connected to the patient almost, relatively speaking, on a 24/7 basis.

[See also: Patient engagement gains momentum]

Q: Is patient engagement more difficult at a children's hospital? Or is it a little bit easier in some sense because it relies significantly on the parents?

A: The pediatric world has different challenges. It’s definitely not about the engagement of the parent with a kid or a child. Most parents will do everything for their child. There's more of that. I think the issue we have with children’s hospitals is we have younger parents, less structured, less educated about certain issues and conditions, and it may be their first child, and it all adds to a little bit more complexity in the education process. …We do know one thing for sure: This generation that we're in today, predominantly the mom and dad in the pediatric world, definitely are mobile savvy and mobile aware. They want to have their information, and they want to have it now. So we feel that the engagement from that perspective – getting them engaged that early on – will get us a much better outcome earlier because they like the idea of being engaged on mobile and not face-to-face. They don’t like the face-to-face. They like texting, and they like to look it up on a handheld.

Q: What does patient engagement look like at Miami Children's? Talk a bit about what you've been working on at the hospital.

A: We have things like (a) discharge application. It's a mobile app. In the past, you'd get a ton of paperwork when you go home, and then you'd go home and you'd read it – if you did read it – or you forgot it in the car. Now, the moment you're discharged from one of our facilities, you'd get automatic discharge instructions, which (are) the same thing you would have gotten on paper but in a mobile format. And you're able to review this discharge and know what the doctor said. The cool thing about that is we're very close to a virtual discharge, which means we will actually videotape the discharge process, especially for a pediatric encounter, and show what the nurse told the parent at the time of discharge to the parent, so they can remember, ‘oh, yes, put the needle in this way, not that way.’ The thing about pediatric care is that mostly moms – dads sometimes but mostly moms – are highly responsible for the care of the kid when they go home. You make sure they get the injections, if it's diabetes. If they're on a pulmonary machine, they have to make sure the ventilator is working correctly, so they become very, very good at caregiving, and the fact that we’re giving them instructions has made it much better.

In addition to that, we've created an application called the ‘handoff app,’ which is actually for the clinical side – not so much for the patient side – but it has a huge implication on the patient side. It's tied to an application on the patient side called ‘Care Notes.’ Care Notes gives the parent an absolute, exactly-what's-happening-in-the-electronic-medical-record view into the world of what we're doing to take care of the kid at any time. And the handoff app gives the caregivers complete handoff – from caregiver to caregiver – information.

So in the past, one of the biggest errors in medicine has been – in addition to medication errors – has been the handoff opportunity, so what happens is: I'm the provider of a patient, and at 6 o'clock I go home, and someone else takes over for me. If I don't sit down and explain to them, 'Look, the patient's been throwing up every two hours, and here's what's going on, and here's what I did,' I have to make sure I write that in the chart, but sometimes that doesn't get to the chart. What normally happens is there is a handoff process that occurs verbally that says, ‘hey, remember to do this,’ or ‘hey, remember to do that.’…very key and factual data that allows the next caregiver to take care of the patient better. Well, that's missed in the translation all the time, so what we've created is an app that allows the caregiver to enter that information quickly on a mobile device and pass it to the next caregiver, and it can even record a video that can record voice notes. It can make it very, very easy for the next caregiver to know what's going on with the kid, especially with the more chronic condition kids.

We've created an app, for example, for medication reminders and adherence – which is tied to the Surescripts clearinghouse – so we know when you don't take your medication, and it's tied back to our electronic medical record, so when you show up in the ED with your child and say, 'My child is still coughing, and I was here two days ago,' we look and say, 'Well you haven't taken your medication in two days. You never went to the pharmacy to take the medication,' we know where to target. That happens frequently for us because a lot of these kids are on Medicaid, and what happens is their parents don't have the money for the prescription, and as a result they're embarrassed to say it. ...

Then we have apps that are a little bit more non-clinical. For example, we have the world's first hospital with Wi-Fi triangulation navigation, which means, that I can actually walk into the hospital, say I want to go to pulmonary, and I’m sitting in one location, and I press my app, and it walks me right to that pulmonary location because it actually knows where I’m physically at in the hospital.

Q: Regarding the meaningful use Stage 2 view, download, transmit requirement, we’ve seen that the real challenge is not necessarily on the technology side of things, but rather it's how does the provider control, in a sense, patient behavior. Is that a difficulty for folks at Miami Children's?

A: No, I don't say so. I can't say without a doubt that it is or it isn't. I think there's probably a little bit of that, but for the most part. …The thing is most parents are really involved in the care of their child. …Most parents will want to do the extra thing, so for example we rolled out our discharge application; we're getting 98 percent compliance in terms of utilization, so everybody is using the apps.

Q: What is patient engagement's biggest roadblock right now? Is it that much of the technology is still immature? Is it lack of standards, unwillingness of the patients, etc.?

A: I think the patient engagement piece has a lot to do with the culture in the organization, so the processes have to become aligned with the technology world. You can't continue the old way of doing business when you're bringing in these new ways of doing business.

A very basic example: If I'm using a discharge app that’s electronic, why am I still providing paper? Or what time do you want to stop providing paper so that people are more geared toward, 'forget about this bulk of paper. Look at this video, it will tell you everything you need to know.’ As you move into that direction, you have to abandon old ways, and (for) hospitals, we don’t do that really well; we wind up adding complexity because we keep adding one process over another process over another process, and it’s just the way it’s always been forever.

So the big challenge I think is organizationally how do you adapt to a new way of doing business, and if you’re able to do that as an organization, then the success is greater.